African Americans (AAs) are four times as likely as whites to have end stage renal disease (ESRD), but only half as likely to receive kidney transplants, the optimal treatment for ESRD. Race disparities exist in the (a) overall rate of transplantation; (b) type of transplant received [i.e., deceased donor kidney transplantation (DDKT) versus living donor kidney transplantation (LDKT)]; and, (c) early post-transplant health outcomes. One of the best ways to reduce racial disparities in transplantation may be to increase the rate of LDKT among AAs. Although it is known that LDKT is the optimal treatment for ESRD, and that AAs receive LDKTs at much lower rates than whites, the reasons for this disparity among patients already referred for transplant are poorly understood. Further, even among the group of patients who receive LDKT, race disparities in early post- transplant health outcomes persist. Known biological differences associated with race (e.g., presensitization or heightened immune response, donor co-morbid health conditions) do not fully explain the observed racial disparities. Thus, the central goals of this prospective cohort study are to understand (a) the culturally-related and psychosocial factors associated with race disparities in LDKT, and (b) the relationship of those factors with early post-transplant health outcomes in a sample of AA and white transplant candidates. The proposed project will take an interdisciplinary approach in developing a bio-psychosocial model to understand race disparities in LDKT. It will control for demographic characteristics (e.g., age, gender, SES), and physical health factors (e.g., physical health, co-morbidities, post-transplant adherence) in order to understand the role of culturally-related factors (e.g., medical mistrust, perceived racism and discrimination, religious beliefs, family networks), transplant related beliefs (e.g., knowledge, decision-making factors, transplant attitudes) and psychosocial factors (e.g., depression/anxiety, social support, coping strategies) on race disparities in LDKT. This prospective cohort study will assess patients (n=1775) at two critical time points leading to transplantation (pre-transplant work-up and completion of transplant evaluation), and at 6 months post-transplant. Predictor variables will be assessed via telephone interview at pre-transplant work-up. Whether or not patients completed transplant evaluation will be assessed at the second time-point through medical record abstraction, and patients' perspective of the quantity and quality of interactions with transplant staff will be assessed with a follow-up interview after transplant evaluation is completed. Finally, type of transplant received as well as early post-transplant health outcomes will be assessed using a final follow-up telephone interview, and additional medical record abstraction. Findings from this study are an essential step toward the long-term goal of developing patient, provider, and system-level interventions to increase rates of LDKT and improve post- transplant health outcomes among African Americans. PUBLIC HEALTH RELEVANCE: African Americans are four times as likely as whites to have end stage renal disease (ESRD), but only half as likely to receive a living donor kidney transplant (LDKT), the best treatment for ESRD. Because known biological differences do not fully explain the observed racial disparities, this project will examine how culturally-related factors are associated with barriers and facilitators to LDKT and subsequent early post-transplant health outcomes. Findings from this study are needed in order to develop patient, provider, and system-level interventions to increase rates of LDKT and improve post-transplant health outcomes among African Americans.